Brain Death ; diagnosis ; Humans

The volatile oil is the main component in the leaves of Perilla frutescens. According to the main types of monoterpenoids or aromatic compounds, it can be divided into different chemotypes and the main chemotypes of Chinese producing Perilla are PA type (mainly containing Perilla aldehyde and limonene), PK type (mainly containing perillaketone) and PP type (subdivided as PP-a type, with apiole as its main component; PP-m type, with myristicin as its main component; PP-e type, with elemicin as main component; PP-as type, with asarone as main component). Based on the biosynthetic pathways analysis, we also found that the formation of the particular chemotype is usually controlled by a single gene or a few genes, and different types have different pharmacological effects. In this paper, the classification under the species P. frutescens, main chemotypes of the volatile oil, and their biogenesis and regulation, pharmacological effect and influence factors are summarized and reviewed.
Animals ; Humans ; Oils, Volatile ; analysis ; pharmacology ; toxicity ; Perilla frutescens ; chemistry ; classification ; metabolism ; Plant Leaves ; chemistry

The study aimed to establish a population pharmacokinetic/pharmacodynamic (PPK/PD) model of warfarin. PCR-RFLP technique was used to genotype the CYP2C9 and VKORC1 polymorphisms of 73 patients. RP-HPLC-UV method was used to determine the 190 plasma concentrations of warfarin. Application of NONMEM, the clinical information and 263 international normalized ratio (INR) monitoring data were used to investigate the effect of genetic, physiological, pathological factors, other medication on clearance and anticoagulant response. The final model of warfarin PPK/PD was described as follows: CL = θCL · (WT/60)θWT · θCYP · eηCL (if CYP2C9*1/*1, θCYP = 1; if *1/*3, θCYP = 0.708); EC50 = θEC50 · θVKOR · eηEC50 (if VKORC1- 1639AA, θVKOR = 1; if GA, θVKOR = 2.01; V = θV; K(E0) = θK(E0); Emax = θEmax; E0 = θE0 · eηE0. Among them, the body weight (WT), CYP2C9 and VKORC1 genotype had conspicuous effect on warfarin PK/PD parameters. The goodness diagnosis, Bootstrap, NPDE verification showed that the final model was stable, effective and predictable. It may provide a reference for opitimizing the dose regimen of warfarin.
Anticoagulants ; pharmacology ; Body Weight ; Cytochrome P-450 CYP2C9 ; genetics ; Genotype ; Humans ; International Normalized Ratio ; Nonlinear Dynamics ; Polymorphism, Genetic ; Vitamin K Epoxide Reductases ; genetics ; Warfarin ; pharmacokinetics

Bone Screws ; utilization ; Female ; Foot Diseases ; surgery ; Fracture Fixation, Internal ; instrumentation ; methods ; Humans ; Internal Fixators ; utilization ; Metatarsus ; abnormalities ; surgery ; Osteochondritis ; congenital ; surgery ; Young Adult

Objective To analyse the experience and treatment of early phase severe acute pancreatitis (SAP) in intensive care units (ICU).Methods A multicenter retrospective study was done on patients with SAP treated in three major teaching hospitals (Beijing Hospital,Peking University First Hospital and Peking University Shenzhen Hospital) in China from Jan.2001 to Dec.2011.Results There were 188 patients who were enrolled in the study,including 121 males and 67 females.The age ranged from 19 to 104 (51.0±18.2) years.The mean APACHE Ⅱ score was (22.2±4.6).84.0％ of patients survived,the mortality was 10.1％ in the early phase and 5.9％ in the late phase.The most common systemic complications were acute renal injury (46.3 ％),acute respiratory distress syndrome (35.6％),and septic shock (17.6％).The local complication rate was 47.3％,which included acute peripancreatic fluid collections (32.8％),acute necrotic collection and walled-off necrosis (48.4 ％) and pseudocyst (18.8 ％).The conservative treatments included intensive care,fluid resuscitation,mechanical ventilation,continuous renal replacement therapy,antibiotics,glucose control,inhibition of pancreatic enzyme activity and secretion,and nutritional support.Surgical intervention included endoscopic retrospective cholangio-pancreatography and endoscopic sphincterectomy,B ultrasound or CT guided puncture and drainage,and surgical drainage and debridement of necrosis.Conclusions The early phase of SAP was characterized by systemic inflammatory response syndrome and multiple organ dysfunction syndrome which accounted for the first peak in mortality.Intensive care therapy and multi disciplinary comprehensive combined strategy were very important for these patients with systemic and local complications.ICU treatment in the early phase was preferred for patients with SAP.

Objective To investigate the relation between coagulation disorders and sepsis severity of infected patients.Methods In this retrospective study,75 patients,51 males,24 femalse,with age(55.8± 18.1),were included from January 2010 to March 2011.They were clinically diagnozed as infection,and had Thromboelastography(TEG)and routine coagulation test within 24 hours after admission to emergency department.They were divided into 3 groups based on SIRS and SOFA score within 24 hours after admission:a)infection group,patients without SIRS; b)sepsis group,patients with SIRS and SOFA score less than 5; c)severe sepsis group,patients with SOFA score greater than or equal to 5.LSD was used to compare between two groups if one-way ANOVA of three groups comparasion showed significant differences.Results In comparasion to sepsis group(n =29)and infection group(n =27),D-dimer elevated significantly in severe sepsis group(n =19)(F =3.388,P =0.004),and platelet count decreased significantly(F =3.839,P =0.026),INR and KPTT showed an increase trend without significant difference (F =2.657,P =0.077 ; F =2.782,P =0.069); TEG showed MA obviously decreased(F =5.841,P =0.004),while there were nostatistically significant differences among other data.Conclusions The extent of coagulation disorders and sepsis severity of infected patients is closely correlated to each other.

Objective To describe the clinical and imaging manifestations of patients with synovitis acne pustulosis hyperostosis osteomyelitis (SAPHO) syndrome,and to analyze the diagnostic importance of different clinical and imaging manifestations for SAPHO syndrome. Methods Seventeen patients (7 males and 10 females) with SAPHO syndrome were recruited in this study.Age ranged from 36 to 67 years with a mean age of (48 ± 8) years. All patients fulfilled the diagnostic criteria of Benhamou. Serum HLA B27 antigen records were reviewed for all patients. Imaging data of the abnormal bone sites were collected by conventional radiograph in all patients,CT in 13 patients as well as MR in 3 patients.Average time to take for a definite diagnosis of the syndrome was 3.7 years (ranged from O.5 to 13 years).Results Serum HLA B27 antigen was positive in all patients. Both skin and bone abnornalities were found in all patients.Ten patients had skin palmoplantar pustulosis and two patients had acne. Involving sites of bone and joints include sacroiliac joints,anterior chest and limbs.Sacroiliac joints were asymmetrically involved with imaging features in all patients.Eight patients exhibited anterior chest wall involvement. Five patients had osteomyelitis at limbs. For all images of 17 patients,CT was superior to conventional radiography in detecting abnormal changes of bone erosion and soft tissue swelling.MR imaging was able to depict edema changes that was not detectable by CT and radiography.Conclusion SAPHO syndrome is a rare disease,but for patients with skin and bone-joint abnormalities,especially with skin palmoplantar pustulosis,acne as well as with imaging features at the sacroiliac joint and anterior chest wall,SAPHO syndrome should be taken into a diagnostic consideration.

Objective To construct and implement theSTARnurse training model, and discuss its application effect and the problems that should be paid attention to, and to provide operational cases and practical basis for nursing clinical education. Methods Through literature review and expert consultation, the framework and content of STAR nurse training model were set up and implemented. The questionnaire survey and semi structured in-depth interviews were conducted among the nurses in the hospital to evaluate the effect of improving the nurses′self-directed learning ability. Results After the implementation of the project, the scores of the three dimensions of self-management, desire for study and self-control were (3.67±0.57), (4.05±0.54), (3.99±0.50) points, which were higher than (3.55±0.49), (3.71± 0.52), (3.53±0.42) points before implementation. The difference was statistically significant (P<0.05 or 0.01). The semi structured in-depth interviews showed that all the nurses believed that STAR nurse training model could promote independent learning and stimulate interest in learning. 14 nurses thought it was beneficial for the nurses to find the problems. Conclusions STAR nurse training model can create a favorable learning environment for nurses, and stimulate the learning motivation. It plays a positive role in improving nurses′ability of self-directed learning.

Objective To study the clinical result of the surgical treatment of upper cervical vertebra disease from high anterior cervical retropharyngeal approach.Methods Among 14 patients,there were 7 C_(2.3)disc hernia- rions combined with C_(2.3)dislocations,3 Hangman fractures,2 odontoid process fractures and 2 C_3 tumors.All patients underwent the high anterior cervical retropharyngeal approach.10 cases were given discectomy of C_(2.3)or focus clear- ance of C_3,iliac bone autograft or titanium cage filled and internal fixation with titanium plate.2 cases of odontoid process fractures were given anterior screw fixation.Results 14 cases got successful exposure.The decompression, reduction,lesion clearance and fusion with internal fixation were done in all patients.There were no important vascu- lar or nerve injuries.The surgical treatment could improve the spinal cord nerve function to a certain degree for the cases with compression of spinal cord.Conclusion Good exposure of upper cervical spine and effective surgical oper- ation could be achieved from high anterior cervical retropharyngeal approach,with minimal trauma and complication, and it was a favorable approach.

Objective To evaluate the clinieal significance of classification for intrahepatic cholestasis of pregnancy (ICP) on diagnosis and management of ICP. Methods A retrospective analysis was conducted on 1340 cases of ICP admitted to our hospitaI from January 2000 to December 2007.AIl subiects were divided to mild and severe ICP groups.AIl clinical data were retrieved,and clinical manifestations,biochemicsl indicators,mode of delivery,perinatal outcomes were analyzed between the two groups. Results These 1340 ICP cases occupied 8.58% of all the maternity inpatients during the study period.Among those delivered in the hospital(n=1058),including 52 twin pregnancies,the preterm birth rate was 11.72 oA(124/1058),the neonatal asphyxia rate was 2.07%(23/1110),and the perinatal mortality rate was 1.08%(12/1110).Skin pruritus was the main symptom in 75.97%(1018/1340) of all cases and no significant difference was found in theproportion of women with skin pruititus between mild and severe ICP cases [74.89%(522/697) vs 77.14%(496/643),X~2=0.94,P>0.05].The perinatal mortality rate(1.02%vs 1.46%),neonatal asphyxia rate(2.30% vs 1.82%)and preterrn birth rate(11.61 vs 12.04%)showed no difference between women with and without skin pruritus among those delivered in the hospital(all P>0.05).Comparisons between those women with CG≥64.43 μmol/L vs CG<64.43μmol/L,those with AST and/or ALT≥250 U/L vs both AST and ALT<250 U/L,those with TBA≥40 μmol/L vs DOI:10.3760/cma.j.issn.1007-9408.2010.02.005 TBA<40 μmol/L,the perinatal mortality rate,neonatal asphyxia rate and preterm birth rate were all lower in the former groups(all P<0.05).The average gestations at delivery was later in mild ICP women than in the severe ones[(38.3±1.9)weeks vs(36.1±1.7)weeks,P<0.05].And the cesarean section rate(73.73%va 97.33%),preterm birth rate(6.13 0A vs 18.28%),neonatal asphyxia rate(1.05%vs 3.49%) and perinatal mortality rate (0.18% vs 2.26%)in the mild ICP cases were all lower than in the severe ICP women(all P<0.05). Conclusions It ia helpful for the management of ICP by dividing ICP cases into mild or severe ones.Cesarean section ia recommended for severe ICP,and trial of labor may be possible for mild cases under close monitoring.